China’s bureaucracy has a lot to handle these days: rooting out corruption, facilitating global trade, censoring independent thoughts online that might “endanger state security.” But on Sept. 6 the Chinese Health Ministry issued a 41-page set of guidelines that was two years in the making. The topic? Technical Guidelines on Intervention When an Old Person Has Fallen Down.

So what’s a witness to a fallen elderly citizen in China to do? Lots of basic medical advice is contained in the guide, which is available for download and cautions that falls are the main cause of death among Chinese 65 and older: check for head injuries, perform CPR if needed, clear airways But the Health Ministry’s handbook also admonishes bystanders “not to help them up in a hurry, but to observe and inquire about their health conditions first and then act accordingly.”

For anyone who has witnessed the disregard of crowds in China, the advice borders on comical. Chinese accidents and other public mishaps often garner lavish gawking but helpful intervention isn’t as common. Last Sunday morning, an 88-year-old resident of the central Chinese city of Wuhan slipped near a vegetable market and landed face down on the street. Roughly 90 minutes elapsed and a vigorous crowd formed around him. But no one bothered to actually help the elderly man, reported the Xinhua state news service. An autopsy found he had died from suffocating on a nosebleed—a preventable death, one presumes, if anyone had investigated.

A lot has been written about why helping hands can be uncommon in China. Some people blame the corrosive effects of a flawed communist ideology. But there also may be a legal impediment to Good Samaritan instincts, according to local media. “The government should focus on re-establishing social trust as the top priority after a series of cases across the country where people trying to help were instead wrongly accused of causing the accident,” wrote the ShanghaiDaily. “Some old people even tried to sue people who rushed to their aid.” The Shanghai Daily was referring to a notorious case in the eastern city of “Nanjing in 2006, [when] Peng Yu helped an old woman up after she fell near a bus stop, but she then accused Peng of pushing her down. A court ruled in her favor and Peng was ordered to pay 40,000 yuan (US$6,255) compensation.” (The case was later settled, but Peng was still liable for a portion of the legal fees.) A poll by the People’s Daily, the state mouthpiece, found that nearly 90% of 2,425 people surveyed online would refuse to help an elderly person who had fallen down, lest they land in legal hot water.

China hardly has a monopoly on public reluctance to help out. In recent months, I’ve witnessed similar incidents in Kazakhstan and Indonesia, to name just two places. Earlier this year, a Chinese man stabbed his mother in the Shanghai airport with nary an intervention from Chinese onlookers. Eventually a foreigner dashed to help, but the Beijing-based Global Times ran an editorial headlined: “Heartless bystanders not solely Chinese problem.” The piece went on to describe a so-called “bystander effect” in which “Columbia University researchers tested the theory on unwitting subjects and found that the more people there are present in an emergency situation, the less likely it is any individual will feel the need to act. Everyone’s responsibility diminishes with the crowd.” Unfortunately China’s massive population means a lot of crowds.